First-episode Non-affective Psychosis Research Articles

Aripiprazole-induced Hepatitis: A Case Report.

Aripiprazole is an atypical antipsychotic that acts as a partial agonist of dopamine type 2 receptors as well as 5-HT1A receptors. It is used in the treatment of schizophrenia and in type 1 bipolar disorder for mania. Because aripiprazole is well tolerated with few side effects it is used off-label in other psychotic disorders. The prevalence of abnormal liver function tests with antipsychotic use is 32%, with clinically significant effects in 4% of cases. No cases of aripiprazole-induced liver injury have been published. We report a 28-year-old female who presented with non-affective first-episode psychosis and who was treated with aripiprazole. Initially she was medicated with 10 mg per day, with an increase to 20 mg per day on the 12th day of hospitalization. Nine days after she became icteric, with nausea and had a vomiting episode. Laboratory analysis revealed a very high level of alanine aminotransferase, and minor to moderately high levels of aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, and bilirubin. Aripiprazole was tapered and paliperidone was started with the improvement of clinical and laboratory findings.

First-episode psychosis and substance use in Nelson Mandela Bay: Findings from an acute mental health unit.

BackgroundUse of psychoactive substances is a common finding in studies on first-episode psychosis (FEP), and this has prognostic implications. We know very little about psychoactive substance use (SU) among patients with FEP in the Eastern Cape province (EC) of South Africa (SA).AimThe study seeks to determine SU prevalence and associated features among inpatients with non-affective FEP in an acute mental health unit (MHU) in Nelson Mandela Bay, EC.SettingResearchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses, and demographics. Data were then subjected to statistical analysis.MethodsResearchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses and demographics. Data were then subjected to statistical analysis.ResultsA total of 117 patients (86 [73.5%] males; 31 [26.5%] females) aged 18–60 years (mean 29 years) met the inclusion criteria. After controlling for missing information, 95 of 117 (81.2%) patients had a history of active or previous SU, 82 of 90 (91.1%) were single and 61 of 92 (66.3%) were unemployed. A significant association was found between SU and unemployment (p < 0.001), as well as male sex (p < 0.001). The most common substances used were cannabis (59.8%), followed by alcohol (57.3%) and stimulants (46.4%).ConclusionIn keeping with national and international literature, the results of this study showed a high prevalence of substance use in South African patients with first-episode psychosis. The high prevalence of lifetime substance use in this cohort compared to previous studies in South Africa requires further investigation and highlights the urgent need for dual diagnosis services in the Eastern Cape province.

Altered syntactic abilities in first episode patients: An inner phenomenon characterizing psychosis

BackgroundResearch has consistently shown that language abilities represent a core dimension of psychosis; however, to date, very little is known about syntactic comprehension performance in the early stages of psychosis. This study aims to compare the linguistic abilities involved in syntactic comprehension in a large group of First Episode Psychosis (FEP) patients and healthy controls (HCs). MethodsA multiple choice test of comprehension of syntax was administered to 218 FEP patients (166 non-affective FEP patients [FEP-NA] and 52 affective FEP patients [FEP-A]) and 106 HCs. All participants were asked to match a sentence they listen with one out of four vignettes on a pc screen. Only one vignette represents the stimulus target, while the others are grammatical or non-grammatical (visual) distractors. Both grammatical and non-grammatical errors and performance in different syntactic constructions were considered. ResultsFEP committed greater number of errors in the majority of TCGB language domains compared to HCs. Moreover, FEP-NA patients committed significantly more non-grammatical (z = −3.2, p = 0.007), locative (z = −4.7, p < 0.001), passive-negative (z = −3.2, p = 0.02), and relative (z = −4.6, p < 0.001) errors compared to HCs as well as more passive-affirmative errors compared to both HCs (z = −4.3, p < 0.001) and FEP-A (z = 3.1, p = 0.04). Finally, we also found that both FEP-NA and FEP-A committed more grammatical (FEP-NA: z = −9.2, p < 0.001 and FEP-A: z = −4.4, p < 0.001), total (FEP-NA: z = −8.2, p < 0.001 and FEP-A: z = 3.9, p = 0.002), and active-negative (FEP-NA: z = −5.8, p < 0.001 and FEP-A: z = −3.5, p = 0.01) errors compared to HCs. ConclusionsThis study shows that the access to syntactic structures is already impaired in FEP patients, especially in those with FEP-NA, ultimately suggesting that language impairments represent a core and inner feature of psychosis even at early stages.

Self and world experience in non-affective first episode of psychosis

A disturbance of “minimal self,” — of the immediate sense of mine-ness inherent in experience—is hypothesized to be the core disturbance in schizophrenia. Research with the Examination of Anomalous Self Experience (EASE) has demonstrated the selective aggregation of anomalous self-experiences in the schizophrenia spectrum. Conceptual research suggests that anomalous world experiences, including changes in the experience of space, time, and other persons, occur alongside anomalous self-experiences and are an important aspect of subjectivity in schizophrenia. The Examination of Anomalous World Experience (EAWE) is a recently published interview format designed to explore changes in world experience in schizophrenia. In the current study, 24 hospital outpatients with non-affective first-episode psychosis and 24 healthy-control participants were assessed with the EAWE and the EASE. First episode psychosis patients had total EAWE and EASE scores that were both, on average, significantly higher than the healthy-control group. EAWE and EASE scores were highly correlated, even after removing overlapping items. The distribution of EAWE items and subtypes in the first-episode psychosis sample was heterogeneous. We conclude that anomalous world experiences represent a relevant aspect of first-episode psychosis, and that they may be related to the self-disturbances thought to underlie schizophrenia spectrum disorders.

PROFIP: A Portuguese early intervention programme for first-episode psychosis in Lisbon.

There is currently no national plan for early intervention in first-episode psychosis in Portugal. Consequently, there is some heterogeneity in the evaluation and treatment of first-episode psychosis across the country. The aim of this article is to provide a complete description of the early intervention programme Programa de Intervenção nas Fases Iniciais da Psicose (PROFIP) in Lisbon, a pioneering team in Portugal for treating first-episode psychosis (FEP) patients. We also describe the baseline socio-demographic and clinical data obtained from new patients over a 1-year period. PROFIP programme accepts all cases of FEP, taking a transdiagnostic approach. Description of PROFIP programme and baseline socio-demographic and clinical data obtained from new patients over a 1-year period. The team was constituted to provide early detection, treatment and support to people aged 16 to 35 years with affective and non-affective FEP. Over a 1-year period, 39 patients were included in the PROFIP programme. The majority of patients were young male patients with a diagnosis of non-affective psychosis, and with 56% of patients reporting cannabis use. Patients received pharmacological and psychosocial interventions based on evidence and individual needs. Our team allowed young people with early psychosis to receive effective care. We do need improvements, namely in referrals and the education of health professionals. More teams in our country should be constituted, allowing larger numbers of patients with early psychosis to be treated by specialized teams.

Cannabis consumption and non-alcoholic fatty liver disease. A three years longitudinal study in first episode non-affective psychosis patients

IntroductionIncreased incidence of obesity and excess weight lead to an increased incidence of non-alcoholic fatty liver disease (NAFLD). Recent evidence indicates a protective effect of cannabis consumption on weight gain and related metabolic alterations in psychosis patients. Overall, patients are at greater risk of presenting fatty diseases, such as NAFLD, partly due to lipid and glycemic metabolic disturbances. However, there are no previous studies on the likely effect of cannabis on liver steatosis. We aimed to explore if cannabis consumption had an effect on hepatic steatosis, in a sample of first-episode (FEP) non-affective psychosis. Material and methodsA total of 390 patients were evaluated at baseline and after 3 years of initiating the antipsychotic treatment. Anthropometric measurements and liver, lipid, and glycemic parameters were obtained at both time points. All but 6.7% of patients were drug-naïve at entry, and they self-reported their cannabis use at both time points. Liver steatosis and fibrosis were evaluated through validated clinical scores (Fatty Liver Index [FLI], Fibrosis-4 [FIB-4], and NAFLD). ResultsAt 3-year follow-up, cannabis users presented significantly lower FLI scores than non-users (F = 13.874; p < .001). Moreover, cannabis users less frequently met the criteria for liver steatosis than non-users (X2 = 7.97, p = .019). Longitudinally, patients maintaining cannabis consumption after 3 years presented the smallest increment in FLI over time, which was significantly smaller than the increment in FLI presented by discontinuers (p = .022) and never-users (p = .016). No differences were seen in fibrosis scores associated with cannabis. ConclusionsCannabis consumption may produce a protective effect against liver steatosis in psychosis, probably through the modulation of antipsychotic-induced weight gain.

Psychometric validation of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in a Danish clinical sample

BackgroundThe Childhood Trauma Questionnaire – Short Form (CTQ-SF) is a widely utilized self-report instrument in the assessment and characterization of childhood trauma. Yet, research on the instrument’s psychometric properties in clinical samples is sparse, and the Danish version of the CTQ-SF has not been previously evaluated in clinical samples. ObjectivesTo examine the structural validity, internal consistency reliability, and multi-method convergent validity of the CTQ-SF in a heterogenous clinical sample from Denmark. Participants and settingThe study was based on data from four Danish clinical samples (N = 393): 1) Outpatients diagnosed with personality disorders, 2) Patients commencing psychiatric treatment for non-affective first-episode psychosis, 3) Patients diagnosed with first-episode or prolonged depression recruited from general practitioners and an outpatient mood disorder clinic, and 4) detained delinquent boys. MethodsConfirmatory factor analysis was used to explore structural validity. Also, we calculated internal consistency and multi-method convergent validity with interview-based ratings of adverse parenting. ResultsConfirmatory factor analyses indicated that the five-factor structure described in CTQ-SF manual with three error correlated items best fitted the data, as compared to various other models. Coefficients of congruence also supported factorial similarity across countries (i.e. US substance abuser and a mixed Brazilian sample). Internal consistency reliability was acceptable and comparable to estimates previously published. Multi-method convergent validity associations further corroborated the validity of the CTQ-SF. ConclusionThese findings provide support for the reliability and validity of the Danish version of the CTQ-SF in clinical samples.

Symptomatic Correlates of Vitamin D Deficiency in First-Episode Psychosis.

Previous studies indicate that low levels of vitamin D are associated with increased severity of psychiatric symptoms in chronic multiepisode psychosis (MEP). We aimed to compare vitamin D levels between first-episode psychosis (FEP) and MEP and to investigate the correlations between vitamin D levels and symptoms in FEP patients. The participants were adults aged 18-45 years who presented with affective and non-affective FEP to an early intervention team in Portugal. Depression was assessed using the Beck Depression Inventory, and positive and negative symptoms and general psychopathology were measured with the Positive and Negative Syndrome Scale. Blood samples were analyzed for 25-hydroxyvitamin D (25OHD). Thirty-three patients completed the study in the FEP group and 33 in the MEP group. FEP patients had low levels of 25OHD (18.16 ± 7.48 ng/mL), with no significant differences from MEP patients. Low 25OHD was significantly correlated with high severities of depressive (r=-0.484, p=0.004) and negative (r=-0.480, p=0.005) symptoms as well as general psychopathology (r=-0.569, p=0.001) in FEP patients. Multiple regression revealed an inverse association between general psychopathology and vitamin D level (p=0.027). More investigation of the association of vitamin D and schizophrenia is needed, namely, using a nonpatient control group and trying to clarify possible causality between vitamin D and psychiatric symptoms.

Neurocognitive Effectiveness in Treatment of First-episode Non-affective Psychosis: 3-years Follow-up

Neurocognitive Effectiveness in Treatment of First-episode Non-affective Psychosis: 3-years Follow-up

Do young adolescents with first-episode psychosis or ADHD show sensorimotor gating deficits?

Early identification is important for patients with early-onset schizophrenia (SZ). Assessment of (candidate) endophenotypic markers for SZ, such as prepulse inhibition of the startle reflex (PPI), may help distinguish between the early-onset SZ and other psychiatric disorders. We explored whether PPI deficits usually seen in adult-onset SZ are present in young adolescents with either early-onset psychosis or attention deficit/hyperactivity disorder (ADHD). Twenty-five adolescents with first-episode, non-affective psychosis (FEP), 28 adolescents with ADHD and 43 healthy controls (HC), aged 12-17 years, were assessed with an auditory PPI paradigm. No significant group differences were found in PPI. However, when the FEP group was divided into those already diagnosed with SZ (n = 13) and those without (N-SZ) (n = 12), and all four groups (SZ, N-SZ, ADHD and HC) were compared on percentage PPI in the 85/60 trials, significantly less PPI was found in patients with SZ than in the HC as well as the ADHD group. No significant group differences were found in explorative analyses on the other trial types. Additionally, startle magnitude was significantly higher in SZ than in N-SZ patients. Young adolescents with SZ showed sensorimotor gating deficits similar to those usually found in adults with SZ and had larger startle magnitude than patients with other types of non-affective early-onset psychosis. No sensorimotor gating deficits were found in adolescents with ADHD. Our findings support the theory that deficient PPI is endophenotypic for SZ.

Patterns of recovery course in early intervention for FIRST episode non-affective psychosis patients: The role of timing

BackgroundPrevention of symptom relapse and promotion of functional recovery are the two main goals of early intervention following a first episode of non-affective psychosis (FEP). The identification of patterns of recovery is important in developing and implementing recovery focused interventions at set time interval. MethodPatterns of recovery course, in terms of symptomatic and functional remission, were explored at 1 and 3-year follow-up in a sample of 373 consecutive FEP patients. Relapses during this period were considered. ResultsFour patterns of recovery course were defined: good stable (26%), good unstable (21%), poor unstable (10%), poor stable (43%). Those who met criteria for good stable recovery were more likely have less severe baseline negative symptoms (OR = 2.092; 95% CI = 0.99–4.419) and to not be diagnosed with schizophrenia (OR = 2.242; 95% CI = 1.015–4.954). Short DUP (OR = 2.152; 95% CI = 0.879–5.27) and low premorbid IQ (OR = 2.281; 95% CI = 0.954–5.457) increased the likelihood of good unstable recovery. Less severe baseline negative symptoms (OR = 3.851; 95% CI = 1.422–10.435) and single status (OR = 4.307; 95% CI = 1.014–18.293) increased the likelihood of a poor unstable recovery. Poor unstable pattern was significantly associated with a high relapse rate (73%). ConclusionsOur results shed light on identifying different recovery patterns in FEP. Despite evidence for early intervention effectiveness, we should explore ways to prevent relapse and improve long-term recovery, particularly in reference to the role of timing in the design of interventions.

Effect of cannabis on weight and metabolism in first-episode non-affective psychosis: Results from a three-year longitudinal study

Cannabis smoking is highly prevalent among patients with psychotic disorders. Its use has been found to be related to clinical characteristics and the prognosis of the disorder. Recent evidence indicates a protective effect of cannabis on weight gain and related metabolic alterations. However, there are no previous studies on the long-term longitudinal effects of cannabis on first-episode drug-naïve patients, which would thereby avoid the confounding effects of chronicity and previous treatment exposure. We aimed to explore the effect of cannabis smoking on weight and lipid/glycaemic metabolic measures in a sample of first-episode non-affective psychosis patients. Anthropometric measurements and glycaemic and lipid parameters were obtained at baseline and three years after initiation of treatment. Patients self-reported their cannabis use at both time points. To explore the longitudinal effect of cannabis, patients were divided into three groups: continuers, discontinuers and non-users. Cannabis users at baseline presented a lower weight ( F=14.85, p<0.001), body mass index ( F=13.14, p<0.001), total cholesterol ( F=4.85, p=0.028) and low-density lipoprotein-cholesterol ( F=6.26, p=0.013) compared to non-users. These differences were also observed after three years: weight ( F=8.07, p=0.005), body mass index ( F=4.66, p=0.032) and low-density lipoprotein-cholesterol ( F=3.91, p=0.049). Moreover, those patients discontinuing cannabis use presented a higher increase in weight ( F=2.98, p=0.052), body mass index ( F=2.73, p=0.067) and triglyceride-high-density lipoprotein ratio ( F=2.72, p=0.067) than the 'non-users' and 'continuers'. The study suggests that cannabis use may produce a protective effect against weight gain and related metabolic alterations in psychosis. However, these results need to be replicated in a larger sample size.

Understanding the implementation of coordinated specialty Care for Early Psychosis in New York state: A guide using the RE-AIM framework.

Consistent evidence shows that early interventions for individuals with psychosis lead to improvements in symptoms, social functioning and treatment satisfaction. These results, combined with the allocation of specific funds for early psychosis services, have contributed to the emergence and dissemination of coordinated specialty care for early psychosis in the United States. Despite the rapid growth of such services across the country over the last 5 years, implementation processes are not yet well understood. We employ the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to describe processes, achievements and challenges of an early psychosis program called OnTrackNY that has been implemented in New York State. OnTrackNY is a coordinated specialty care program that delivers early intervention services that include both medications and psychosocial interventions to youths experiencing a first episode of non-affective psychosis. By drawing on outcome and care process data that are collected quarterly from all OnTrackNY sites, we describe the status of each RE-AIM dimension regarding OnTrackNY implementation followed by an evaluation of both achievements and shortcomings. In general terms, OnTrackNY has shown to be a scalable and sustainable model for addressing early psychosis, reaching and providing recovery-oriented services to a large population in need. Despite its advancements, a series of limitations pose challenges to the implementation and maintenance of the model including, but not to, the lack of incentives for coordination of services, the fragmentation of child and adult services, and concerns about financial sustainability.

Does childhood trauma predict poorer metacognitive abilities in people with first-episode psychosis?

Research suggests that people with first-episode psychosis (FEP) report more childhood traumas and have lower metacognitive abilities than non-clinical controls. Childhood trauma negatively affects metacognitive development in population studies, while the association remains largely unexplored in FEP populations. Metacognition refers to the identification of thoughts and feelings and the formation of complex ideas about oneself and others. This study hypothesized that childhood trauma would be associated with lower metacognitive abilities in people with FEP. In a representative sample of 92 persons with non-affective FEP, we assessed childhood trauma, metacognitive abilities and symptoms of psychosis. We used the Childhood Trauma Questionnaire (CTQ) and the Metacognitive Assessment Scale––Abbreviated which includes Self-reflectivity, Awareness of the Mind of the Other, Decentration and Mastery. Hierarchical regression analyses were performed with metacognitive domains as outcome variables and childhood traumas as independent variables, while controlling for age, gender, first-degree psychiatric illness and negative symptoms. We found few significant associations between the different types of childhood trauma and metacognitive domains, and they suggested childhood trauma are associated with better metacognitive abilities. Study limitations included the cross-sectional design and use of self-report measures. Future studies could preferably be prospective and include different measures of psychopathology and neuropsychology.

Early-Stage Negative Symptom Trajectories and Relationships With 13-Year Outcomes in First-Episode Nonaffective Psychosis.

Negative symptoms are a key treatment target in early psychosis intervention. There is a paucity of research examining longitudinal course of negative symptoms across the initial years of treatment for first-episode psychosis using individual-based trajectory analysis. No study has been conducted investigating differential relationships of early-stage negative symptom trajectories with long-term distal outcomes. This study examined patterns and baseline predictors of negative symptom trajectories over the first 3 years of treatment in 138 patients aged 18-55 years presenting with first-episode nonaffective psychosis, using latent class growth analysis based on symptom ratings measured at 4 different time points (baseline, 1, 2, and 3 years). We further explored prospective relationships of identified trajectory classes with functional and negative symptom outcomes at 13-year follow-up. Our results revealed 3 distinct negative symptom trajectories including minimal-stable (59.6%), mild-stable (29.4%), and high-increasing (11.0%) trajectories. Poorer premorbid adjustment, more severe global cognitive impairment, and depressive symptoms at baseline were found to predict high-increasing trajectory. Among 3 trajectory classes, patients in high-increasing trajectory had the worst functional and negative symptom outcomes at 13-year follow-up, with post hoc analyses demonstrating significant outcome differences between high-increasing and minimal-stable trajectories. Our findings thus affirm a heterogeneous course of negative symptoms in first-episode psychosis and indicate that early-stage negative symptom trajectories are critically associated with long-term outcomes. Patients displaying persistently high negative symptom levels in the initial 3 years of treatment may represent a specific subgroup who necessitates an extended period of early intervention specifically targeting at negative symptoms to promote early functional recovery.

Predicting suicidal behaviour after first episode of non-affective psychosis: The role of neurocognitive functioning

BackgroundSuicide has been recognised as one of the major causes of premature death in psychosis. However, predicting suicidal behaviour (SB) is still challenging in the clinical setting and the association of neurocognition with SB in psychosis remains poorly understood. This study aimed to investigate the role of neurocognitive performance as predictor of SB. Also, we sought to explore differences in the evolution of clinical and neurocognitive functioning between participants with/without history of suicide attempts (SA) over follow-up period. MethodsThe sample of the study is composed by 517 patients. Sociodemographic, clinical, functional and neurocognitive measures were evaluated at baseline as well as 1-year and 3 years after first episode of psychosis. Bivariate and multivariate analyses explored the influence of these variables as putative baseline predictors of SB. Repeated measures analyses of variance tested differences in clinical and neurocognitive outcomes at 1- and 3-year follow-up. ResultsGlobal cognitive functioning (GCF) (OR = 1.83, 95% CI = 1.25–2.67) and severe depressive symptoms (OR = 1.17, 95% CI = 1.07–1.28) predicted SB. Longitudinal analyses revealed that patients with SB at follow-up presented with higher levels of remission in terms of positive psychotic symptoms and depression. In addition, those with a history of SB had worse GCF and visual memory than those without such antecedents. ConclusionsGCF was found to be the most robust predictor of SB along with severe depressive symptomatology. Hence, poorer cognitive performance in FEP appears to emerge as a risk factor for suicidal behaviour from early stages of the illness and a comprehensive neurocognitive assessment may contribute to risk assessment.

Predictors of Symptom Severity and Functioning in First Episode Psychosis

There is dearth of studies on the role of critical socio-demographic and clinical variables on psychopathology and functional outcome in persons with first episode psychosis (FEP), especially from lower and middle income countries. Therefore, we studied the predictors of psychiatric symptom severity and socio-occupational dysfunction among persons with non-affective FEP in India. Using multiple linear regression models, we examined the role of gender, previous admission, psychiatric co-morbidity, duration of psychosis, and duration of untreated psychosis (DUP) on psychiatric symptom severity and socio-occupational dysfunction among 71 persons with non-affective FEP. The participants were recruited from a tertiary mental health center in South India. The Brief psychiatric Rating Scale (BPRS) and Social Occupational Functioning Scale (SOFS) were used measure symptom severity and socio-occupational dysfunction respectively. Gender (male), presence of co-morbid psychiatric illness, higher duration of psychosis, and longer DUP significantly increased psychiatric symptoms and socio-occupational dysfunction. The independent variables predicted 40% variance on psychiatric symptoms and 37% variance on socio-occupational dysfunction. Both regression models were significant at p < 0.001 level. The study is helpful to understand the common predictors of symptoms and functioning in FEP. However, future studies need to examine the role of other critical mediating variables on psychopathology and functions to evolve a comprehensive pathway model.

The right occipital lobe and poor insight in first-episode psychosis.

Lack of insight is a core feature of non-affective psychosis and has been associated with poorer outcomes. Brain abnormalities underlying lack of insight have been suggested, mostly in the frontal lobe, although previous research showed mixed results. We used a voxel-based morphometry (VBM) analysis in 108 first-episode non-affective psychosis patients to investigate the pattern of brain structural abnormalities related to lack of insight. In addition, 77 healthy volunteers were compared with the patients classified as having poor and good insight. The shortened version of the Scale to Assess Unawareness of Mental Disorder was used to evaluate insight. Patients with poor insight (n = 68) compared with patients with good insight (n = 40) showed a single significant cluster (kc = 5834; PcFWE = 0.001) of reduced grey matter volume (GMV) in the right occipital lobe extending to its lateral and medial surfaces, the cuneus, and the middle temporal gyrus. In addition, GMV at this cluster showed a negative correlation with the score of the SUMD (r = -0.305; p = 0.001). When comparing patients with poor insight with healthy subjects overall reductions of GMV were found, mainly in frontal and occipital lobes. Hence, poor insight in non-affective psychosis seems to be associated with specific brain abnormalities in the right occipital and temporal cortical regions. Dysfunction in any combination of these areas may contribute to lack of insight in non-affective psychosis. Specifically, the ‘right’ hemisphere dysfunction underlying impaired insight in our sample is consistent with previously reported similarities between lack of insight in psychosis and anosognosia in neurological disorders.

Age of onset of Cannabis use and cognitive function in first-episode non-affective psychosis patients: Outcome at three-year follow-up

BackgroundIn recent years, the effects of cannabis use on cognitive functions in patients with psychosis have been widely studied. Recently, special emphasis has been placed on the impact of age at the onset of consumption on cognition in these patients. Method349 patients with a first episode of non-affective psychosis were studied. Patients were classified as cannabis users and non-users. Users were divided, according to their age when they began using cannabis, into: early-onset (age < 16) and late-onset (age ≥ 16) users. Differences between groups at baseline were studied based on sociodemographic, clinical, and cognitive variables. The groups were longitudinally (3-year) compared on cognitive variables. ResultsOut of the 349 patients included in this study, 38.7% (N = 135) were cannabis users. Of them, 39.3% (N = 53) were early-onset and 60.7% (N = 82) were late-onset cannabis users. No baseline differences were found between the early-onset and late-onset groups on cognitive domains. Longitudinally, only patients who had withdrawn from cannabis use during follow-up showed a significant improvement in verbal memory. ConclusionOur results did not show differences between the early-onset group and the other two groups in long-term cognitive performance, even if they kept consuming cannabis during the first three years of disease progression. Further studies are needed to elucidate the true relationship between early-onset cannabis use and cognitive function in patients with a first episode of psychosis.

F81. AGE OF ONSET OF CANNABIS USE AND COGNITIVE FUNCTION IN FIRST EPISODE NON-AFFECTIVE PSYCHOSIS PATIENTS: 3-YEAR FOLLOW-UP OUTCOME

BackgroundIn recent years, the effect of cannabis use on cognitive functions in patients with psychosis has been widely studied, but results are somewhat contradictory. On the other hand, it has also been studied the relevance of the age of onset of consume, suggesting that the early age of onset of consumption may be related to a greater cognitive impairment.Methods349 patients with a first episode of non-affective psychosis were studied. Patients were classified in cannabis users and non-users. Users were divided according to their age at the beginning of use of cannabis in: early-onset (age<16) and late-onset (≥16 years-old). Differences between groups at baseline were studied on sociodemographic, clinical and cognitive variables. The groups were longitudinally (3-year) compared on cognitive variables.ResultsOut of the 349 patients included in this study, 38.7% (N=135) were cannabis users, of them 39.3% (N=53) started consuming before 16 years of age and 60.7% (N=82) did so at age 16 of after. No differences were found between early-onset and late-onset groups on cognitive domains. However, cannabis users (early and late) showed significantly worse performance in processing speed than non-users. Longitudinal analises revealed that the groups of early-onset, late-onset and non-users of cannabis, had different evolution in processing speed domain and in the global cognitive functioning.DiscussionThe main findings of this study were that, although there were differences between patients who used cannabis and those who did not, minimal differences aroused between the early-onset and late-onset cannabis users. With respect to longitudinal analyses, we must be careful with their interpretation, since although a priori we found a significant group by time interaction (early-onset, late-onset, and non-users) in some domain, when the cannabis use at 3-year follow-up was considered, results did not show any significance, this reveals that cannabis users (early-onset and late-onset) and non-cannabis users did not differ in the degree of change in their cognitive functions, regardless of whether or not the patients had maintained consumption during the first 3-year of disease progression.